Are Covid Therapeutics Still Being Developed? 

As of the beginning of 2023, there were three FDA-authorized treatments for general use against COVID-19, as well as 14 treatments approved for emergency use against the virus [1]. Despite these options, thousands of people still succumb to SARS-CoV-2-related deaths each day, indicating the continuing gaps in Covid therapeutics – more effective therapeutics still need to be developed [2]. Not only must therapeutics be effective in preventing hospitalization and clinical deterioration, but they should also present a satisfactory safety profile and be inexpensive [3]. To meet this need, as of January 22nd, 2023, the FDA reported that Covid therapeutics are still being developed by more than 700 ongoing programs encompassing a variety of different therapeutic methods [1]. 

Potential Covid therapeutics could take one of several forms and operate through distinct pathways. Types of therapeutics include antivirals, which prevent viruses from multiplying; immunomodulators, which tamper the body’s reaction to the virus; and neutralizing antibody therapies, which can boost the immune system’s response [1]. Therapies also differ according to their respective operational pathways. While some therapeutics, like remdesivir, inhibit viral replication by blocking enzyme insertion into viral RNA chains, others, like tocilizumab, act via uptake pathways [4]. And a third category may operate through novel pathways, for example by performing metabolic reprogramming [4]. This range of options represents the vast latitude currently explored in clinical development trials [4]. Different angles of attack may be needed to supplement currently available Covid therapeutics, making it important for candidate treatments to still be developed. 

With the possible mechanisms of therapeutics established, one can now turn to some of the ongoing drugs being developed to treat COVID-19. One such prospect is apabetalone, an epigenetic inhibitor currently in advanced clinical trials [5]. Specifically, researchers suspect that apabetalone may be effective against SARS-CoV-2 variants, particularly delta and omicron [5]. While this medication does not appear to affect the incidence of infection, research indicates that apabetalone is anti-inflammatory and may restrict ongoing infection [5]. Along with its favorable safety profile, these effects suggest it is a promising COVID therapeutic [5]. 

Another promising therapeutic candidate is CD24F2, “a small glycosylphosphatidylinositol-anchored cell surface glycoprotein” that may be useful for treating hospitalized COVID patients [6]. So far, research indicates that CD24F2 can modulate the body’s inflammatory response and restore homeostasis in already-infected individuals [7]. Current studies also indicate that the medication is well-tolerated and could be useful in treating especially severe patients who are on oxygen support [6]. 

Lastly, a therapeutic capable of treating long COVID is still needed and being developed [8]. Three years into the pandemic, medical practitioners have yet to land on a preferred or even consistent tool for addressing long COVID, which may affect anywhere from 5 to 30% of all people infected by SARS-CoV-2 [8]. Institutions like Stanford Medicine are currently running clinical trials aimed at developing such a tool [8]. Stanford’s STOP-PASC trial aims to see if Paxlovid, a Pfizer-developed oral antiviral medication, could assuage the symptoms of long COVID [8]. For now, this hypothesis will remain untested, as the trial is currently in its recruitment phase [8]. 

With these various clinical trials underway, the prospect of landing on a variety of effective, inexpensive, and safe COVID therapeutics and, thus, finally bringing an end to the pandemic, becomes more promising. 

References 

[1] FDA, “Coronavirus Treatment Acceleration Program (CTAP),” Updated January 24, 2023. [Online]. Available: https://www.fda.gov/drugs/coronavirus-covid-19-drugs/coronavirus-treatment-acceleration-program-ctap.   

[2] H. Ledford, “Hundreds of COVID trials could provide a deluge of new drugs,” Nature, Updated March 1, 2022. [Online]. Available: https://www.nature.com/articles/d41586-022-00562-0.   

[3] P. C. Robinson et al., “COVID-19 therapeutics: Challenges and directions for the future,” PNAS, vol. 119, no. 15, pp. 1-10, April 2022. [Online]. Available: https://doi.org/10.1073/pnas.2119893119.  

[4] D. Basu, V. P. Chavda, an A. A. Mehta, “Therapeutics for COVID-19 and post COVID-19 complications: An update,” Current Research in Pharmacology and Drug Discovery, vol. 3, pp. 1-16, 2022. [Online]. Available: https://doi.org/10.1016/j.crphar.2022.100086.  

[5] L. Fu et al., “Dual mechanism: Epigenetic inhibitor apabetalone reduces SARS-CoV-2 Delta and Omicron variant spike binding and attenuates SARS-CoV-2 RNA induced inflammation,” Internal Immunopharmacology, vol. 117, pp. 1-13, April 2023. [Online]. Available: https://doi.org/10.1016%2Fj.intimp.2023.109929.  

[6] J. Welker et al., “Efficacy and safety of CD24Fc in hospitalised patients with COVID-19: a randomised, double-blind, placebo-controlled, phase 3 study,” Journal of Hematology & Oncology, vol. 22, no. 5, pp. 611-621, May 2022. [Online]. Available: https://doi.org/10.1016/S1473-3099(22)00058-5.  

[7] N. Song et al., “Treatment with soluble CD24 attenuates COVID-19-associated systemic immunopathology,” Journal of Hematology & Oncology, vol. 15, no. 5, pp. 1-18, January 2022. [Online]. Available: https://doi.org/10.1186/s13045-021-01222-y.  

[8] B. Goldman, “Stanford Medicine clinical trial goals: Meet long COVID head-on, treat it and defeat it,” Stanford Medicine, Updated March 8, 2023. [Online]. Available: https://med.stanford.edu/news/all-news/2023/03/long-covid-pandemic-anniversary.html.